Patients with combined pelvic and spinal injuries have worse clinical and operative outcomes than patients with isolated pelvic injuries analysis of the German Pelvic Registry

Abstract

Background Pelvic fractures are often associated with spine injury in polytrauma patients. This study aimed to determine whether concomitant spine injury influence the surgical outcome of pelvic fracture. Methods We performed a retrospective analysis of data of patients registered in the German Pelvic Registry between January 2003 and December 2017. Clinical characteristics, surgical parameters, and outcomes were compared between patients with isolated pelvic fracture (group A) and patients with pelvic fracture plus spine injury (group B). We also compared apart patients with isolated acetabular fracture (group C) versus patients with acetabular fracture plus spine injury (group D). Results Surgery for pelvic fracture was significantly more common in group B than in group A (38.3% vs. 36.6%; p = 0.0002), as also emergency pelvic stabilizations (9.5% vs. 6.7%; p < 0.0001). The mean time to emergency stabilization was longer in group B (137 ± 106 min vs. 113 ± 97 min; p < 0.0001), as well as the mean time until definitive stabilization of the pelvic fracture (7.3 ± 4 days vs. 5.4 ± 8.0 days; p = 0.147). The mean duration of treatment and the morbidity and mortality rates were all significantly higher in group B (p < 0.0001). Operation time was significantly shorter in group C than in group D (176 ± 81 min vs. 203 ± 119 min, p < 0.0001). Intraoperative blood loss was not significantly different between the two groups with acetabular injuries. Although preoperative acetabular fracture dislocation was slightly less common in group D, postoperative fracture dislocation was slightly more common. The distribution of Matta grades was significantly different between the two groups. Patients with isolated acetabular injuries were significantly less likely to have neurological deficit at discharge (94.5%; p < 0.0001). In-hospital complications were more common in patients with combined spine plus pelvic injuries (groups B and D) than in patients with isolated pelvic and acetabular injury (groups A and C). Conclusions Delaying definitive surgical treatment of pelvic fractures due to spinal cord injury appears to have a negative impact on the outcome of pelvic fractures, especially on the quality of reduction of acetabular fractures.

Patients with combined pelvic and cranio-cerebral-injuries have worse clinical and operative outcomes than patients with isolated pelvic injuries. Analysis of the German Pelvic Registry

“…An link between pelvic injuries and other pelvic injuries has been shown in earlier investigations. Our research team has published two retrospective cohort analyses using the same GPR database: According to Navas et al 10 , individuals with pelvic and spinal injuries combined had poorer clinical and surgical outcomes than patients with isolated pelvic injuries. Küper et al 2 investigated the impact of concurrent abdominal trauma on the timing of surgery, the standard of care provided, and the clinical outcome in pelvic injuries.…”

“…In polytrauma patients with pelvic injuries, approximately 33% also suffer from severe cranio-cerebral injuries [9]. Unfortunately, there is a lack of consistent de nitions, data sources, documentation, treatment methods, epidemiological parameters, and follow-up results, leading to unsatisfactory and highly variable outcomes [10].…”